CAJ | 학술논문

目的探讨CT灌注指导下尿激酶动脉溶栓治疗6～9 h急性脑梗死的疗效与安全性. 方法将自2008年1月至2010年12月入住厦门大学附属第一医院神经内科的52例CT灌注成像提示存在缺血半暗带的发病6～9 h急性脑梗死患者按随机数字表法分为治疗组(n=27)和对照组(n=25).治疗组患者行全脑血管造影(DSA),闭塞部位输注尿激酶行接触溶栓治疗,术后评价闭塞血管再通情况;对照组患者予抗血小板聚集等常规治疗.所有患者在治疗后24 h内复查CT以观察是否合并脑出血,治疗前及治疗后24 h、7d行美国国立卫生研究院卒中量表(NIHSS)评分评定,治疗后90 d用改良Rankin量表(mRS)和Barthel指数(BI)评价临床预后. 结果治疗组患者溶栓治疗后血管成功再通15例[心肌梗塞溶栓评判标准(TIMI)3级9例,TIMI 2级6例],不成功再通12例(TIMI 1级和0级各6例).治疗后24h内2组脑出血发生率相比差异无统计学意义(P＞0.05).治疗后24h、7d时治疗组NIHSS评分改善情况明显优于对照组,差异有统计学意义(P＜0.05);治疗后90 d时良好预后(mRS分级0～Ⅰ级或BI≥95分)比例亦明显高于对照组,差异有统计学意义(P＜0.05). 结论 CT灌注指导下尿激酶动脉溶栓治疗发病6～9 h急性脑梗死是安全有效的,其可以提高血管再通率,改善临床预后.
목적 탐토CT관주지도하뇨격매동맥용전치료6～9 h급성뇌경사적료효여안전성. 방법 장자2008년1월지2010년12월입주하문대학부속제일의원신경내과적52례CT관주성상제시존재결혈반암대적발병6～9 h급성뇌경사환자안수궤수자표법분위치료조(n=27)화대조조(n=25).치료조환자행전뇌혈관조영(DSA),폐새부위수주뇨격매행접촉용전치료,술후평개폐새혈관재통정황;대조조환자여항혈소판취집등상규치료.소유환자재치료후24 h내복사CT이관찰시부합병뇌출혈,치료전급치료후24 h、7d행미국국립위생연구원졸중량표(NIHSS)평분평정,치료후90 d용개량Rankin량표(mRS)화Barthel지수(BI)평개림상예후. 결과 치료조환자용전치료후혈관성공재통15례[심기경새용전평판표준(TIMI)3급9례,TIMI 2급6례],불성공재통12례(TIMI 1급화0급각6례).치료후24h내2조뇌출혈발생솔상비차이무통계학의의(P＞0.05).치료후24h、7d시치료조NIHSS평분개선정황명현우우대조조,차이유통계학의의(P＜0.05);치료후90 d시량호예후(mRS분급0～Ⅰ급혹BI≥95분)비례역명현고우대조조,차이유통계학의의(P＜0.05). 결론 CT관주지도하뇨격매동맥용전치료발병6～9 h급성뇌경사시안전유효적,기가이제고혈관재통솔,개선림상예후.
Objective To determine the safety and efficacy of intra-arterial urokinase in the treatment of acute cerebral infarction (ACI) patients with computed tomography perfusion-based selection within a 6-9 h window.Methods Fifty-two ACI patients,with computed tomography perfusion imaging (CTPI) identifying thresholds for salvageable penumbra,were randomly assigned to intra-arterial thrombolysis with urokinase (group A) and conventional anti-platelet aggregation (group B) within a 6-9 h window.Whole brain digital subtraction angiography (DSA) was done at pre-and post-treatment to observe the recanalization of occlusive vessels in group A.The National Institutes of Health Stroke scale (NIHSS) 24 h and 7 d after treatment,and modified Rankin Scale (mRS) and Barthel Index (BI) 90 d after treatment were used to evaluate the efficacy.Results In group A,15 patients showed successful recanalization (thrombolysis in myocardial infarction [TIMI] index:grade Ⅲ in 9 and grade Ⅱ in 6) and 12 patients showed unsuccessful recanalization (TIMI index:grade Ⅰ in 6 and grade 0 in 6) with a successful recanalization rate of 55.56％.More obvious NIHSS improvement 24 h and 7 d after treatment in group A was observed than that in group B (P＜0.05),and more patients with favorable outcomes based on mRS and BI in group A were noted than those in group B (P＜0.05).In addition,the incidence of cerebral hemorrhage within 24 h of treatment between the two groups was similar (P＞ 0.05).Conclusions Intra-arterial thrombolysis with urokinase is safe and effective for ACI patients within a 6-9 hour window under the guidance of CTPI.